Goal: 

The aim of this study was to evaluate current practice in gastric ulcer follow-up to establish diagnostic yield and predictors of malignancy.

Background: 

Repeat gastroscopy is routinely performed to confirm gastric ulcer healing and exclude malignancy. However, the incidence of malignancy at follow-up endoscopy is low, without consensus regarding case selection and timing.

Study: 

New gastric ulcers diagnosed on gastroscopy at 2 institutions in Australia were identified through keyword search of endoscopy reports over a 5-year period (2013 to 2017). Data collected included patient demographics, clinical presentation, and endoscopic and histologic findings from initial and subsequent gastroscopies.

Results: 

Of 795 patients, repeat gastroscopy was performed in 440 (55%). Malignancy was diagnosed in 52 (7%) with 83% identified at initial gastroscopy. Eight cancers were identified at repeat gastroscopy with malignancy yield of 2% (8/440). Three were diagnosed in patients with benign initial ulcer histology (3/286, 1%). One cancer was diagnosed during follow-up in a patient with benign histology but no repeat gastroscopy (1/286, 0.3%). Predictors of benign ulcers were absence of endoscopic suspicion [odds ratio (OR) 0.1 (0.03-0.13), P≤0.005], complete healing on repeat gastroscopy [OR 0.5 (0.34-0.70), P=0.036] and benign initial histology [OR 0.12 (0.43-0.90), P≤0.005].

Conclusions: 

Seven percent of new gastric ulcers were malignant with most identified with biopsy on initial gastroscopy. Malignancy yield from follow-up gastroscopy was 2%. Diagnostic yield of endoscopic follow-up may be low in ulcers with benign appearance and adequate histology. However, current practice of repeat gastroscopy is warranted in the absence of patient-based and lesion-based predictors of malignancy.

中文翻译：

---

胃溃疡随访中内窥镜操作和结果的评估

目标： 

本研究的目的是评估当前胃溃疡随访实践，以确定诊断率和恶性肿瘤的预测因子。

背景： 

常规进行重复胃镜检查以确认胃溃疡愈合并排除恶性肿瘤。然而，随访内镜检查时恶性肿瘤的发生率较低，且在病例选择和时机方面尚未达成共识。

学习： 

通过对 5 年（2013 年至 2017 年）内窥镜检查报告进行关键词搜索，发现了澳大利亚 2 家机构通过胃镜检查诊断出的新胃溃疡。收集的数据包括患者人口统计、临床表现以及初次和后续胃镜检查的内镜和组织学结果。

结果： 

在 795 名患者中，440 名患者（55%）接受了重复胃镜检查。52 例 (7%) 被诊断为恶性肿瘤，其中 83% 在初次胃镜检查时确诊。重复胃镜检查发现了 8 种癌症，恶性率为 2% (8/440)。其中 3 例是在组织学上诊断为良性初始溃疡的患者中（3/286，1%）。一名组织学良性但未重复胃镜检查的患者在随访过程中诊断出一种癌症（1/286，0.3%）。良性溃疡的预测因素是没有内镜检查怀疑[比值比 (OR) 0.1 (0.03-0.13)，P ≤ 0.005]、重复胃镜检查时完全愈合[OR 0.5 (0.34-0.70)，P = 0.036]和良性初始组织学[或0.12（0.43-0.90），P≤0.005 ]。

结论： 

百分之七的新胃溃疡是恶性的，大多数是在初次胃镜检查时通过活检确诊的。随访胃镜检查的恶性肿瘤发生率为 2%。对于外观良性且组织学充分的溃疡，内镜随访的诊断率可能较低。然而，在缺乏基于患者和基于病变的恶性肿瘤预测因素的情况下，目前重复胃镜检查的做法是有必要的。